小钛板内固定术在头颈部肿瘤手术中的应用

目的评价钛板内固定术在头颈部肿瘤手术中的应用。方法回顾性总结近6年内所做的连续40例小钛板内固定术。主要应用于①有血运的骨组织瓣移植固定（14例）；②口腔及口咽肿瘤手术入路的下颌骨切开复位（12例）；③鼻咽手术的上颌骨掀翻复位固定（11例）；④其他（3例），如骨折固定。以颌骨切开部位是否受放射剂量为标准，共有23例（57.5%）接受了平均60Gy的放射治疗，其中术前放射治疗18例。结果40例患者中出现与钛板有关的并发症11例（27.5%），其中钛板周围伤口感染5例，放射性骨坏死3例，钛板暴露、螺钉松动、骨断端不愈合各1例。手术前后接受放射治疗患者的并发症似乎较非放射治疗患者高（39.1%对比11.8%，P=0.079）。除1例外，所有未发生并发症的有牙颌关系肿瘤患者恢复了正常的咬合关系。手术后平均3～4d开始经口进食，均未用颌间固定。结论小钛板内固定术能达到稳定和准确的颌骨固定，避免了颌间固定，有利于头颈肿瘤患者恢复正常的生活，尤其在骨组织瓣塑形中发挥出独特的优势。出现与钛板有关的并发症可能与手术前后放射治疗有关，采用颌骨正中或旁正中切开一般可避开放射治疗部位，降低并发症。

Titanium miniplate fixation in head and neck cancer surgery

Objective To evaluate the rigid fixation with miniplates in head and neck cancer surgery. Method A consecutive series of 40 patients with head and neck tumor underwent rigid fixation with the Martin titanium miniplates system in a 6 years period. The miniplates were used to fix bone graft reconstruction following mandible resection ( n =14), mandibulotomies for oral and oropharyngeal surgical access ( n =12), maxilla swinging for nasopharyngeal access ( n =11) and other purposes ( n =3). Twenty three of all cases(57.5%) received perioperative radiotherapy with average doses of 60Gy at the osteotomy site.Results Eleven of the 40 patient (22%) developed plate related complication which included 5 infections, 3 mandibular osteonecroses, 1 plate exposure, 1 screw loose and 1 nonunion. Complications were more likely to occur in patients with perioperative radiation than patients without (39.1% versus 11.8%, P =0.079). Except one case, All the uncomplicated dentulous patients demonstrated stable and good occlusion. Oral feeding usually started on the 3 4th day after surgery. There was no need for intermaxillary fixation. Conclusion The miniplate provided stable mandibular or maxillary fixation and accurate repositioning, eliminated the need for intermaxillary fixation. The malleability and versatility of miniplate make it unique in bone graft shaping for mandibular reconstruction. Complication seems to be related to perioperative radiotherapy. Median or paramedian mandibular osteotomy, which is non radiated region in most radiotherapy cases, is advocated.